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Tachypnoea in a well baby: what to do next?
  1. Ian M Balfour-Lynn1,
  2. Michael L Rigby2
  1. 1Departments of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
  2. 2Paediatric Cardiology, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Ian M Balfour-Lynn, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; i.balfourlynn{at}ic.ac.uk

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It is not uncommon to see babies in clinic who have been referred because they are persistently tachypnoeic. Sometimes this has been noticed by the parents, but more often, especially if it is the parents’ first baby, they do not realise anything is amiss, and it is the midwife, health visitor or general practitioner who brings it to their attention. Occasionally it has been noted as early as the postnatal ward. This article outlines a management approach to a term baby with tachypnoea in an outpatient setting, and is not focusing on acutely unwell infants (figure 1). It is taken from the perspective of a referral to a general paediatric clinic, although these babies are also often referred straight to a respiratory clinic.

Figure 1

Algorithm for management of a baby with tachypnoea. CXR, chest radiograph; SpO2, oxygen saturation.

What is tachypnoea?

Aside from the huge physiological changes that occur at birth, in the postnatal period there are substantial changes in the resting breathing pattern of babies, notably a slowing of the rate and a lengthening of inspiration. Paradoxical chest wall movements and short apnoeic pauses (>2 s) during sleep decrease over several months. Infants may also exhibit periodic breathing, which is a pattern of short respiratory pauses (<6 s) that occur in groups of three or more, with less than 20 s of respiration between pauses; the pause is usually followed by a series of rapid shallow breaths. In full term babies periodic breathing is more common during sleep, and is usually seen from 1 week to 2 months of age; it tends to disappear by 6 months and is of no consequence.1 The normal respiratory rate gradually decreases over the 1st year (figure 2). There is no gender difference and the rate is higher in awake babies.2

Figure 2

Respiratory rate in 1st year of life, awake …

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